Multidrug-resistant Escherichia coli: Updated insights into resistance mechanisms, rapid diagnostics, and emerging control strategies

Multidrug-resistant (MDR) Escherichia coli ( E. coli ) is a major global health threat, causing increased morbidity, mortality, and healthcare burden. It is a common cause of community- and hospital-acquired infections, with a strong ability to acquire and disseminate resistance genes via horizontal gene transfer and mutations. This review provides an overview of MDR E. coli , focusing on resistance mechanisms, diagnostic approaches, and control strategies. Key resistance mechanisms include production of extended-spectrum β-lactamases (ESBLs), carbapenemases, efflux pump overexpression, target site alterations, and reduced membrane permeability. Quorum sensing and biofilm formation further enhance bacterial survival and resistance. Diagnostic methods range from conventional antimicrobial susceptibility testing to advanced molecular and genomic techniques such as PCR and whole-genome sequencing. Emerging tools, including Fourier transform infrared spectroscopy, surface-enhanced Raman spectroscopy, MALDI-TOF MS, automated systems, and biosensors, offer rapid and accurate detection. Control strategies involve antimicrobial stewardship programs, alternative therapies such as natural compounds and QS inhibitors, and strict infection prevention measures. Addressing MDR E. coli requires a multidisciplinary approach integrating timely diagnosis, effective treatment, and robust infection control policies. A comprehensive literature search was conducted across major databases, and selected studies were qualitatively analyzed to summarize current knowledge and highlight emerging trends. Understanding these aspects is essential for limiting the spread of MDR E. coli and improving clinical outcomes globally.